Healthcare delivery system is an arrangement that serves best to any country’s population with effective, efficient and fair distributions of resources, and funds through organized infrastructure to thrive well. Better health improves country’s labor force and ultimately raises human welfare and economic stability. This healthy labor force and productive human capital resources can be attained through structured healthcare facilities by the government for its people. Globally, health sectors varies from country to country and it depends on how much expenditures on health is been effectively utilized. In majority of the developing countries, private healthcare sectors, donor, and out of pocket expenditures are the primary contributors in health care services that may raise human capital and economic growth of the country. Whereas, public health sectors remains underprivileged due to structural fragmentation, lack of resources, and functional inabilities. This paper is mainly going to discuss about health care delivery system of Pakistan in comparison to China followed by organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its utilization.

Karachi is one of the biggest City in Asia and since past 20 years terrorism in Karachi is increasing frequently, due to these terrorist activities people living here have developed several phobias and anxiety disorders. To contrast the occurrence of traumatic events and its relationship with symptoms of post-traumatic stress disorder in Karachites. Survey of residents of Karachi was conducted between January 12, 2011 and March 4, 2012. Symptoms of PTSD were assessed using questionnaire related to psycho social factors that prone to PTSD .Out of total 164 both male and females, 62% of respondents reported appetite changes due to these terrifying activities, 58% of respondents reported hostile personalities , depression & mood fluctuations, while remaining 30% reported insomnia. 76.82% reported depression According to their economical condition 71% Middle class was highly affected as compare to upper class and lower class. There was also a significant difference observed among the populations who are engaged both in education and also doing jobs for survivals. 88% of them were found frustrated & protesting against the situation of the city. The results of the current study suggest that the trauma incident by the resident population is significant. Stresses tend to be numerous and chronic. The trauma experienced correlated strongly with psycho social, somatic, PTSD symptoms and depression

It is confirmed that early marriage and early childbirth leads to higher rates of adolescent fertility and pregnancy related complications. According to UNICEF (1994) unfortunately the mortality rate of the married girls aged between 15-19 years is twice as compare to the girls who marry after the age of 20 years. As their bodies are immature that’s why their health is affected by giving birth to a child. Millions of children are affected by the tradition of early marriage at is being practiced and widespread in many regions of South Asia. Early marriage is also called as child marriage that is marriage below the age of 18 when girls are too weak to shoulder their responsibilities physiologically, psychologically and socially. Early married females are more prone to diseases like HIV/AIDS and obstetrics obstacles. They are also affected psychologically and they may become victim of depression, anxiety and other mood disorders. An observational study was conducted between married and unmarried female to know their perspective about getting married early and to highlight whether it is a positive response according to them. Results showed that in relation to unmarried girls the married females were also not in favor of getting married early as they are equally invaded by health problems. Mental distress and depressive symptoms are more common in married females. Girls prefer doctors for concerning their reproductive health problems while girls can also concerned their mothers but they are in minority. Many health consequences are being reported by early married females and they were hesitated to share them with their in laws. Most of them approached lady doctors whereas few were relying on their mothers for their problems to be solved. Marriages below the age of 18 is not helping the females infract its demolishing their self esteem, their will to study and their physiological well being also.

Nursing as a profession today still faces several challenges. There seems a dire need to produce such professional nurses that up bring the dignity of this distinct profession. The heavy responsibility of producing such professional nurses lies in the hands of nursing institutions and primarily the schools and colleges of nursing. The standard of the education offered by these institutions plays an important role in this regard. While addressing at the inaugural ceremony of the Aga Khan University School of nursing and midwifery, His Highness the Aga Khan, chancellor of the Aga Khan University spelt out the vision for the nursing profession in the following words “today, this is the beginning, the birth of a new medical institution in Pakistan, the Aga Khan University…and I hope, this day will also be the dawn of a new dimension for the profession of nursing in Pakistan” (Aga Khan, February 16, 1981). Thus it is important that nursing institutions undergo continuous quality assurance process to maintain the high standards of nursing education to develop nurses that can claim their position in this challenging era.

OBJECTIVES: To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. METHODOLOGY:A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. RESULTS: Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226(69.75%) and out of them, 102(45.13%) were males and 124(54.86%) were females with a P value of 0.039. The mean age was 25.95 ± 9.32 (15-45) years for the patient with fungus. Aspergillus was the commonest organism found. CONCLUSION: Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found.

A good clinical practice (GCP) is an ethical and scientific quality act from oldest enduring customs in the historic times of medicine. As the guiding ethical code it is primarily known for its edict to do no harm to the tolerant. However, the complexities of modern medicine research necessitate a more elaborate set of guidelines that address a physician’s ethical and scientific responsibilities such as obtaining informed consent or disclosing risks of these biohazards. our country in last decades has excelled so much in terms of offering training programs for these professional to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on both male and female working in specific hospitals in Karachi. They were interviewed about their skills, duties and knowledge about standards of clinical practice. With reference to the patient care and conditions they were inquired about the medical background, awareness of the sufferer’s ailment and ethical concerns like patient safety & rights. We have found nearly disappointing results as most of these workers were ignorant of the fact that they lack basic knowledge of related responsibilities of concerned patients. Rest of the data also gave the evidence for a huge breach among the awareness, education and realistic approach in this selected workforce. We suggest that caregivers must be aware of indications and have strong medical foundation of the concerned departments where they are serving. We propose the medical education and clinical workshops of this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and good clinical practice.

A good clinical practice (GCP) is an ethical and scientific quality act from oldest enduring customs in the historic times of medicine. As the guiding ethical code it is primarily known for its edict to do no harm to the tolerant. However, the complexities of modern medicine research necessitate a more elaborate set of guidelines that address a physician’s ethical and scientific responsibilities such as obtaining informed consent or disclosing risks of these biohazards. our country in last decades has excelled so much in terms of offering training programs for these professional to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on both male and female working in specific hospitals in Karachi. They were interviewed about their skills, duties and knowledge about standards of clinical practice. With reference to the patient care and conditions they were inquired about the medical background, awareness of the sufferer’s ailment and ethical concerns like patient safety & rights. We have found nearly disappointing results as most of these workers were ignorant of the fact that they lack basic knowledge of related responsibilities of concerned patients. Rest of the data also gave the evidence for a huge breach among the awareness, education and realistic approach in this selected workforce. We suggest that caregivers must be aware of indications and have strong medical foundation of the concerned departments where they are serving. We propose the medical education and clinical workshops of this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and good clinical practice.

Despite great deal of popular research interest in existence and altered body responses of emotional stress there are still strong arguments regarding its positive and negative impact on psychophysiological health. Stress is a state of mental or emotional strain or suspense and also a number of normal reactions of the body (mental, emotional, and physiological) and designed for self-preservation. The potentially lethal consequences of emotional stress are deeply rooted in folk wisdom, as reflected by phrases such as scared to death and a broken heart. In the past decade, cardiac contractile abnormalities and heart failure have been reported after acute emotional stress. a cross sectional study, data was collected by means of structured questionnaire from 370 subjects (age ranges between 20-50 years). Stress was accessed by using Sadaf Stress Scale (SSS) which comprises of 114 items divided into seven subscales data was analyzed by using SPSS 20.0. The main findings of this study are that emotional stress has a direct relation with age. People ranging below 30 years showed emotional stress and women being remarkably more susceptible to it.

Mentha arvensis (MA) is traditionally used in hypertension and in patients with ischemic heart disease. The scientific rationale for its use is not known. In order to find a pharmacological basis of its use in traditional medicine we made three polarity based fraction from the crude extract of MA and investigated their effects on arachidonic acid metabolism. MA inhibited arachidonic acid metabolite thromboxane B2-a stable analogue of thromboxane-A2, formed via cyclooxygenase pathway and lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid formed via lipoxygenase pathway. More potent inhibition of thromboxane-B2 compared to lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid was observed and indicates MA might possess antiplatelet activity as thromboxane-B2 is one of the strongest proponents of platelet aggregation. When MA was investigated for antiplatelet activity, it was found to inhibit human platelet aggregation induced by arachidonic acid as well as by adenosine diphosphate and platelet activating factor while collagen-induced platelet aggregation was unaffected by MA. Since arachidonic acid-induced aggregation is mediated through thromboxane-A2, these results indicate that inhibition of platelet aggregation may be responsible for the observed beneficial effects of MA in patients with ischemic heart disease. Furthermore, MA was also effective in enhancing glutathione peroxidase activity, although it had no significant effect on superoxide dismutase activity. These activities were however, distributed throughout various fraction of MA.

Renal transplantation represents the best available replacement treatment for patients with end stage renal disease patients than performing dialysis, and living donor transplantation has been shown to offer better graft survival than cadaver donor renal transplantation. It was demonstrated that kidneys from living, unrelated donors succeed as well as kidneys obtained from brothers and sisters who share half of the tissue matching antigens with kidney recipients. The study was carried out at department of Angiography, Sindh Institute of Urology and Transplantation (SIUT) from January 2009 to September 2011. A total of 30 patients were included in the study. Informed consent was taken from all patients. Result demonstrates a total of 115 renal arteries in 60 kidneys of donors were depicted at CT angiography (CTA). Only 57 of kidneys showed more than one or multiple arteries, 52 of these had two renal arteries, and 6 had three renal arteries.

Child Sexual Abuse (CSA) is one of the major public health problems that exist globally. Abuse, is the term which has been using for long period of time since the human societies existed in the world. But, we would like to be more specific to the CSA in Pakistani context. For the purpose, Logical Framework Analysis (LFA) was developed to design project in the community health settings for a health prevention, promotion, and health maintenance of the people living in the community. Child Sexual Abuse, issue was identified after thorough assessment of the community which was prevalent but unreported. LFA approach was used to explore the problems through root cause analysis and discover some of the relevant strategies to solve the identified problems. In conclusion, there is an intense need of awareness regarding child sexual abuse to prevent this problem not only in the community but also at country level.

Mental Stress is a Kind of mental revival or strain that can be aroused by a number of mental tasks–e.g., mental arithmetic, maze solving or a mentally troubled condition is called the mental stress. Major life events as changes in work, financial problems, studies load, children and family problems are few of these. Mental stress is seen to affect parts of the brain where thoughts, approach, speculation and decision making are processed through and stored along with basic motor activities. Constant exposure to mental stress hormones, whether it occurs during the upbringing, teenage years, old age, has an impact on brain structures involved in cognition and mental fitness. The WHO suggests that there can be “no health without mental health”. People in many countries are exposed to harmful stress that leads to an augment in mental stress. The purpose of this study is to evaluate the cause of mental stress in Karachi population through Sadaf stress scale (SSS); various stressors may contribute to these mental stresses. The data was collected from different areas of Karachi .Sadaf stress scale (SSS) was used as an instrument for evaluation of mental stress. Results demonstrates that in age 20 and less shows 16.0% mild level of stress, in age 20 to 30 shows 24.0% mild level of stress, in age 30 to 40 shows 5.0% mild level of stress however 40 and greater age shows no stress levels. The hypothesis that mental stress responses are associated with age and gender was investigated.

The objective of the study was to compare the sensitivity and specificity of ultrasound, X-ray KUB and CT for the diagnosis of ureteral colic in patients with acute flank pain. This study was carried out in Department of Radiology Sindh Institute of Urology and Transplantation (SIUT) from Aug 2010 to Nov 2010. A total of 190 patients with mean age of 35 years were included in the study. All individuals underwent pre procedural imaging X-ray KUB, U/S and CT. On these imaging modalities obstruction of urinary tract and stones were determined. X-ray KUB was done as a guide for U/S exam only. Ureteral stones were confirmed in 190 patients. Specificity for ct was 100% whereas X-ray KUB and U/S was 94% and 76% respectively. Sensitivity for CT 100%, U/S 52.6% and X-ray KUB 89.5% respectively. Some stones were not detected by U/S and few stones were not detected on X-ray KUB due to bowel gases. Cases were correctly diagnosed with all three techniques. CT is the most reliable technique for the detection of uretric stones however, X-ray and U/S also be chosen alternative to CT with a reduce radiation dose.

One of the most complex ethical dilemmas faced by health care professionals working with terminally ill patients is whether, when, how and how much to tell terminal ill patients about their diagnosis and prognosis of disease. Deception is still sometimes used by health care professionals while treating terminally ill patients (Tuckett, 1998). Truth telling to terminally ill patients is a common ethical dilemma that nurses have to deal with on a daily basis when families are reluctant to disclose the poor diagnosis with patients. However, by abiding by certain principles and ethics, the nurses can make the best decision. The purpose of this paper is to review, analyze and evaluate the case scenario in light of four principles of Beauchamp and Childress (2001) namely autonomy, beneficence, non-maleficence, and justice.

After every 16 minutes one individual die not merely from a disease or an accident but intentionally through suicide. Literature reveals that it is a long process usually stretches over years from suicidal ideation to planning and finally an attempt. The causes of suicidal behavior are immense which captivate these poor and innocent creatures in great troubles. In teenagers the suicidal ideations are related to multiple internal and external factors. They consume different lethal liquids and adopt different methods for performing this violent act. Further on its impact is not only on her individual and family life but has a great impact on the society as well. It is not an essay task to eradicate this violent act but as we a responsible member of the society we can assess their suffering and agony and help them identifying different social groups. Along with it we can also prevent the suicide at three different levels that’s primary secondary and tertiary. We can also do the counseling. In conclusion, I would say that it is a rising issue of today’s world and we all must give our efforts to show a reduction in its prevalence.

Health plays an important role in shaping the human capital. Good health enhances the productivity and efficacy of the labor force which leads to the economic growth and human welfare (Settle, 2012). World health organization (WHO) has defined health system as “all organizations, people and actions whose primary intent is to promote, restore or maintain health” (WHO, 2008). Healthcare delivery system is comprehensive therefore; for the analysis purpose; WHO health care system framework will be used (Appendix A). It has six building blocks which will be utilized as an instrument. The six blocks is comprised of leadership, human resource, information, medical products and technology, financing and service delivery. Intermediate output leads to the desired health outcomes (WHO, 2008). This paper presents the comprehensive analysis of the health care systems of Pakistan and United States America with the help of WHO health care system framework followed by health system challenges and concludes with some practical strategies to overcome those challenges.

Purpose of Study: To access the level of emotional stress in general population. Introduction: Despite great deal of popular interest in development of numerous training programs in emotional stress some researchers have argued that there is little evidence that emotional stress is both useful and different from others. Stress is a state of mental or emotional strain or suspense and also a number of normal reactions of the body (mental, emotional, and physiological)and designed for self-preservation. The potentially lethal consequences of emotional stress are deeply rooted in folk wisdom, as reflected by phrases such as scared to death and a broken heart. In the past decade, cardiac contractile abnormalities and heart failure have been reported after acute emotional stress. Methodology: It was a cross sectional study; data was collected by means of structured questionnaire from 370 subjects of different organizations (age ranges between 20-50 years). Measures: Stress was accessed by using Sadaf Stress Scale (SSS) which comprises of 114 items divided into six subscales data was analyzed by using SPSS 20.0. Results: The main findings of this study are that emotional stress has a direct relation with age. People ranging below 30 years showed emotional stress and women being remarkably more susceptible to it.